AT-WILL EMPLOYMENT APPLICATION

(PLEASE PRINT ALL INFORMATION EXCEPT SIGNATURE)


THIS APPLICATION IS NOT AN EMPLOYMENT CONTRACT but merely is intended to evaluate suitability for employment. It is the policy of the company to provide equal employment to all qualified persons without discrimination on the basis of race, color, religion, national origin or ancestry, sex, age, disability, marital status, sexual orientation, genetic information, or because of an individual’s refusal to submit to a genetic test or make available the results of a genetic test, veteran status, or any other legally protected status under local, state, or federal law. It is also the policy of the company to have the option of conducting pre-employment screening before a job offer is made. If a job offer is made, employment may be contingent upon the successful completion of a medical examination, which may include providing body substance samples. This application will remain active for 180 days.


PERSONAL INFORMATION

Name (Required) Date of Birth (Required)
Home Phone (Required) Work Phone (Required)

Please list below your current address and your 2 other most recent addresses:

Street (Required) City (Required) State (Required) Zip (Required) Since (Mo/Yr) (Required)
Street (Required) City (Required) State (Required) Zip (Required) Since (Mo/Yr) (Required)

EDUCATION

High School Attended (Required) City, County and State (Required) Did you earn a Diploma? (Required)
Undergraduate College Attended City, State Areas of Study Degree/Certificate/Diploma
Graduate School Attended City, State Areas of Study Degree/Certificate/Diploma
Trade, Business or Other School City, State Areas of Study Degree/Certificate/Diploma

EMPLOYMENT INFORMATION

Position Applied For (Required) : Date You Can Start Work (Required) : Desired Salary (Required) : $
Do You Prefer (Required): Full-TimePart-Time Can You Work (Required): WeekendsEvenings

Please answer all of the following questions:
Are you at least 18 years of age? (Required) YesNo

If you are under 18 years of age, can you provide required proof of your eligibility to work? (Required) YesNo

Are you and legally eligible for work in the United States? (Required) YesNo

Will you work overtime when necessary? (Required) YesNo

Have you received a description of the job or been made aware of the essential functions of the job you are applying for (Required): YesNo

Do you understand the job requirements? (Required) YesNo

Are you on layoff and subject to recall? (Required) YesNo

Are you currently bound by a noncompetition or trade secret agreement? (Required) YesNo

Have you ever been discharged or asked to resign from a job? (Required) YesNo

EMPLOYMENT HISTORY

MAY WE CONTACT YOUR PRESENT EMPLOYER? (Required) YesNo

Please list below your last 3 employers beginning with the most recent:

Most Recent Employer (Required) City, State, Zip Code (Required) Phone (Required)
Position Held and Dates From/To (Required) Pay Rate Upon Leaving $ (Required) Supervisor (Required)
Duties (Required) Reason for Leaving (Required)

Next Most Recent Employer (Required) City, State, Zip Code (Required) Phone (Required)
Position Held and Dates From/To (Required) Pay Rate Upon Leaving (Required) $ Supervisor (Required)
Duties (Required) Reason for Leaving (Required)

Next Most Recent Employer (Required) City, State, Zip Code (Required) Phone (Required)
Position Held and Dates From/To (Required) Pay Rate Upon Leaving $ (Required) Supervisor (Required)
Duties (Required) Reason for Leaving (Required)

JOB-RELATED SKILLS

Please answer the following questions if the position you are applying for requires driving a motor vehicle:

Do you have a valid driver’s license?
YesNo
(If YES: Driver’s License Number) Date of Issue:

Have you been convicted of or pled guilty to any traffic-related offense within the past five years? (Required) YesNo
(Conviction will not necessarily disqualify you from employment.)

Have you had your driver’s license suspended or revoked or had your driving privileges modified by a court of law? (Required) YesNo
(Suspension or revocation will not necessarily disqualify you from employment.)

Please list all states from which you hold or have held a driver’s license (Required):

Please use this space to list any special skills you may have that relate to the position applied for (Required):

Please list any professional licenses, designations, certifications, etc. that may relate to the position applied for. Include date granted, name of organization and any other relevant information.(Required)

APPLICANT’S CERTIFICATION AGREEMENT

  1. I authorize the investigation of all statements contained in this application and release from all liability any persons or employers supplying such information, and I also release the company from all liability that might result from making the investigation.
  2. I certify that the facts and information set forth in this application are true and complete to the best of my knowledge. I understand that any falsification, misrepresentation, or omission of facts on this application (or on any required documents) will be cause for denial of employment or immediate discipline, up to and including termination of employment, regardless of when or how discovered.
  3. I agree, if I am offered and accept a position, to conform to all existing and future Company rules and regulations and I understand that the Company reserves the right to change policies, title, job description, wages, hours and working conditions as deemed necessary. I ALSO UNDERSTAND THAT, IF HIRED, MY EMPLOYMENT WILL BE AT-WILL, MEANING THAT EITHER PARTY CAN END THE EMPLOYMENT RELATIONSHIP AT ANY TIME AND FOR ANY OR NO REASON, AND THAT ONLY A WRITTEN AGREEMENT BETWEEN THE PRESIDENT OF THE COMPANY AND ME, SIGNED BY BOTH OF US, CAN ALTER THE AT-WILL EMPLOYMENT RELATIONSHIP.
  4. UNDER MARYLAND LAW, AN EMPLOYER MAY NOT REQUIRE OR DEMAND, AS A CONDITION OF EMPLOYMENT, PROSPECTIVE EMPLOYMENT, OR CONTINUED EMPLOYMENT, THAT AN INDIVIDUAL SUBMIT TO OR TAKE A LIE DETECTOR OR SIMILAR TEST. AN EMPLOYER WHO VIOLATES THIS LAW IS GUILTY OF A MISDEMEANOR AND SUBJECT TO A FINE NOT EXCEEDING $100.
  5. I understand that any employment offer is contingent upon my providing, within three (3) working days of employment, valid proof of identity and eligibility to work in order to comply with the Immigration Reform and Control Act of 1986.
  6. I have read and reviewed the information provided in this application and the above statements. By signing this application for employment I certify that I understand all parts of it and have answered all questions completely and fully.
Signature (Required) Date (Required)